三邻甲苯磷酸酯暴发中毒四年的临床观察  

4-year clinical study on fulminant intoxication of tri-o-cresyl phosphate

作　　者：杨家琳 李慧展 牛青盟 

机构地区：[1]西安市未央区第一医院内科,710021 [2]西安市未央区卫生局

出　　处：《中华劳动卫生职业病杂志》2001年第3期212-214,共3页Chinese Journal of Industrial Hygiene and Occupational Diseases

摘　　要：目的　了解三邻甲苯磷酸酯 (TOCP)暴发中毒患者的临床特征 ,并探讨其诊断的敏感指标。方法　对 70例TOCP中毒患者 4年的临床资料进行了分析。结果　患者临床表现符合迟发性中枢 -周围远端型轴索病。食入TOCP的面粉后有一段无症状期 ,平均 46d ,其间无任何胃肠道症状和毒蕈碱样症状。麻痹前突出的症状为腓肠肌疼痛 (95 .7% ) ,是本组患者的首发症状。 3～ 7d后 ,出现由下肢远端开始的多发性周围神经病表现 ;重度中毒患者 (2 0例 )于发病 1个月左右开始出现上运动元麻痹的表现。所有神经损害的表现下肢均早于并重于上肢 ,远端重于近端。 7个月左右时 ,轻度中毒患者肢体功能大多基本恢复到病前水平 ;而重度中毒患者锥体束损害的表现却更加突出 ,10 0 %有肢体残疾。在第 1个月和第 48个月 ,对 10例中毒患者作神经肌电和诱发电位 (EP)检查 ,结果表明 ,下肢肌电图 (EMG)、运动神经传导速度 (MCV)均异常 ;下肢运动诱发电位 (MEP)异常 4例 ,均为中枢运动通路传导时间 (CMCT)延长 ;上肢体感诱发电位 (SEP)异常 2例 ,下肢SEP全部异常。TOCP中毒尚无特效疗法 ,常用B族维生素、ATP等治疗。恢复期针灸、按摩等有助于肢体功能的恢复。结论　腓肠肌疼痛对TOCP中毒具有诊断价值 ,EMG、神经传导速度、EP检查可作为诊断的?Objective To investigate the clinical features of the patients with fulminant poisoning of tri o cresyl phosphate(TOCP). Method 4 year clinical data from 70 cases was statistically analyzed. Results The clinical manifestation was consistent with the delayed pericentral distal axon disease.The incipient symptom was pain in gastrocnemius before paralysis(95.7%) and after 3～7 days multiple peripheral nerve injury developed from lower limbs.20 patients with severe intoxication had the symptom of upper motor neurons paralysis in about 1 month after invasion.The whole manifestation of nerve injuries were more severe at lower limbs than upper limbs and at distal ends than proximal ends.After about 7 months, the limbs function of most patients with mild intoxication recovered but pyramidal tract injuries in patients with severe intoxication were aggravated,100% of them had limb disability.Examination on 10 patients at the first and the 48th month after intoxication,showed that all of them had abnormal lower limbs electroneuromyography(EMP),motor conduction velocity(MCV),and 4 of them had abnormal motor evoked potential(MEP) by prolongation of central motion conduction time(CMCT);and 2 and 10 patients had abnormal upper limbs sensory evoked potential(SEP) and lower limb SEP respectively.There was no specially good therapy for TOCP.VB CO and ATP are commonly used,acupuncture and massage are used to promote the recovery of limb function. Conclusion Pain in gastrocnemius is valuable for diagnosis of TOCP intoxication and EMG,nerve conduction velocity(MCV) and EP may be sensitive indicators.

关 键 词：磷酸酯类 周围神经系统疾病 TOCP 化学性中毒 临床症状 临床检查 治疗 

分 类 号：R135.1[医药卫生—劳动卫生]